Echocardiographic pulmonary hypertension probability is associated with clinical outcomes after transcatheter aortic valve implantation.

Autor: Nijenhuis VJ; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. Electronic address: v.nijenhuis@antoniusziekenhuis.nl., Huitema MP; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands., Vorselaars VM; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands., Swaans MJ; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands., de Kroon T; Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands., van der Heyden JA; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands., Rensing BJ; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands., Heijmen R; Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands., Ten Berg JM; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands., Post MC; Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2016 Dec 15; Vol. 225, pp. 218-225. Date of Electronic Publication: 2016 Oct 06.
DOI: 10.1016/j.ijcard.2016.10.010
Abstrakt: Aims: Pulmonary hypertension (PH) is associated with mortality after transcatheter aortic valve implantation (TAVI). However, diagnosis based on tricuspid regurgitant velocity (TRV) is often inaccurate and unreliable. The updated PH guidelines introduced a PH probability grading implementing additional PH signs on transthoracic echocardiography (TTE), from which we aimed to analyse its effects on clinical outcomes in patients undergoing TAVI.
Methods and Results: We included 591 consecutive patients (mean age 80.2±8.4years, 58.0% female, mean STS risk score 6.2±3.8%) undergoing TAVI. Patients were divided into "low" (n=270; TRV ≤2.8m/s without additional PH signs), "intermediate" (n=131; TRV ≤2.8m/s with additional PH signs, or TRV 2.9-3.4m/s without additional PH signs), and "high" PH probability (n=190; TRV 2.9-3.4m/s with additional PH signs, or TRV >3.4m/s). The overall 30-day and 2-year mortality rates were 10.2% and 33.8%, respectively. "High" PH probability was an independent predictor of mortality at 30days (HR 3.68, 95% CI 2.03 to 6.67, p<0.01) and 2years (HR 2.19, 95% CI 1.57 to 3.04, p<0.01), compared to "low" PH probability. The "intermediate" group did not show an increased risk. The presence of additional PH signs resulted in a significantly higher mortality at 30days (19.6% vs. 5.1%, p<0.01) and two years (54.2% vs. 22.5%, p<0.01).
Conclusions: The updated echocardiographic PH probability model incorporating additional PH signs independently predicts early and late mortality after TAVI. Additional PH signs are of great value in assessing one's risks since its presence is strongly associated with early and late mortality.
(Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)
Databáze: MEDLINE
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